Utility of established prognostic scores in COVID-19 hospital admissions: multicentre prospective evaluation of CURB-65, NEWS2 and qSOFA

Abstract

IntroductionThe COVID-19 pandemic is ongoing, yet, due to the lack of a COVID-19-specific tool, clinicians must use pre-existing illness severity scores for initial prognostication. However, the validity of such scores in COVID-19 is unknown.MethodsThe North West Collaborative Organisation for Respiratory Research performed a multicentre prospective evaluation of adult patients admitted to the hospital with confirmed COVID-19 during a 2-week period in April 2020. Clinical variables measured as part of usual care at presentation to the hospital were recorded, including the Confusion, Urea, Respiratory Rate, Blood Pressure and Age Above or Below 65 Years (CURB-65), National Early Warning Score 2 (NEWS2) and Quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) scores. The primary outcome of interest was 30-day mortality.ResultsData were collected for 830 people with COVID-19 admitted across seven hospitals. By 30 days, a total of 300 (36.1%) had died and 142 (17.1%) had been in the intensive care unit. All scores underestimated mortality compared with pre-COVID-19 cohorts, and overall prognostic performance was generally poor. Among the ‘low-risk’ categories (CURB-65 score<2, NEWS2<5 and qSOFA score<2), 30-day mortality was 16.7%, 32.9% and 21.4%, respectively. NEWS2≥5 had a negative predictive value of 98% for early mortality. Multivariable logistic regression identified features of respiratory compromise rather than circulatory collapse as most relevant prognostic variables.ConclusionIn the setting of COVID-19, existing prognostic scores underestimated risk. The design of new prognostic tools should focus on features of respiratory compromise rather than circulatory collapse. We provide a baseline set of variables which are relevant to COVID-19 outcomes and may be used as a basis for developing a bespoke COVID-19 prognostication tool.

Impacts of Demographic and Clinical Characteristics on Disease Severity and Mortality in Patients with Confirmed COVID-19

“…However, studies of patients with COVID-19 have shown that 17% mortality occurs among patients with a CURB-65 score of < 2. 27 Bradley et al stated that low CURB-65 scores may not support early COVID-19 discharge, but higher scores are useful for predicting poor outcomes, consistent with our findings. 27 In our study, CURB-65 score on admission was also significantly higher among non-surviving patients than among surviving patients.…”

Prognostic accuracy of emergency department triage tools for adults with suspected COVID-19: the PRIEST observational cohort study

“…The conventional thresholds for positivity of scores above 4, 1 and 0 offered suboptimal sensitivity (0.79, 0.63 and 0.83), with corresponding specificities of 0.69, 0.91 and 0.69. Bradley et al (n=830) 18 reported c-statistics of 0.67 for NEWS2 and 0.74 for CURB-65 as predictors of 30-day mortality, with sensitivities and specificities at conventional thresholds of 0.83 and 0.37 for NEWS2, and 0.80 and 0.59 for CURB-65. Ma et al (n=305) 19 reported c-statistics of 0.79 for NEWS2 and 0.85 for CURB-65 for predicting death.…”

The Prognostic Accuracy of National Early Warning Score 2 on Predicting Clinical Deterioration for Patients With COVID-19: A Systematic Review and Meta-Analysis

“…The recent outbreak of coronavirus disease 2019 (COVID- 19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has challenged healthcare systems worldwide (1). As of , SARS-CoV-2 has results in more than 12.5 million confirmed cases, with more than 2.7 million deaths (2).…”